Receipt 401ES - South Carolina

STATE OF SOUTH CAROLINA COUNTY OF: ________________________ IN THE MATTER OF: _____________________________________ (Decedent) ) ) ) ) ) ) ) IN THE PROBATE COURT RECEIPT CASE NUMBER: _________________________ The undersigned hereby acknowledges receipt from the Personal Representative(s) in this matter of the following property: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Executed this _____ day of ___________________________, 20_____. Recipient Signature: Print Name: *Witness Signature: Print Name: *The Personal Representative is not allowed to serve as the witness. FORM #401ES (1/2014) 62-3-1001 American LegalNet, Inc. www.FormsWorkFlow.com